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Nearly 5,000 disabled Kansans languishing on waiting lists for Medicaid services must become a higher financial priority for Gov. Sam Brownback's administration in the wake of long-awaited federal endorsement of a key piece of the governor's plan to adapt Medicaid to a private-sector, managed-care structure.

The price Brownback must pay for implementation of the final segment of his KanCare overhaul touching 350,000 Kansans is tied to a federal mandate that state officials pour "a portion" of cost savings achieved through improved medical outcomes and program efficiency into opening slots for 3,100 disabled people on the state's "unserved" waiting list. These disabled people qualify for Medicaid, but have been denied long-term support services because the state declined to earmark sufficient funding.

Last year, Brownback directed $37 million in KanCare savings to create 650 new slots over a two-year period for these unserved Kansans. Waiting lists were developed over many years and sustained through Republican and Democratic gubernatorial administrations.

"We're committed to a reduction in the number of people on the waiting list," said Angela de Rocha, spokeswoman for the Kansas Department for Aging and Disability Services. "The most important thing is to get them what they need."

The agreement with the Medicaid division of the U.S. Department of Health and Human Services also stipulated the Brownback administration review within six months all 1,700 cases of disabled Kansans on the "underserved" waiting list.

No one in Kansas, according to the agreement, can be added to the underserved waiting list. Decisions to authorize or deny supplemental services must be made within 180 days for each of these Medicaid recipients, who receive some but not all residential or employment aid for which they qualify.

"The importance of eliminating the DD underserved waiting list cannot be understated," said Rocky Nichols, executive director of the Disability Rights Center of Kansas. "Now, all their service needs must be met."

The Disability Rights Center concluded last year the state's maintenance of an underserved waiting list violated federal law, but Brownback administration officials did little more than acknowledge uncertainty about the legal issue.

The bulk of Brownback's transition of Medicaid to a managed-care system controlled by three insurance companies contracting with the state was implemented Jan. 1, 2013. Bipartisan opposition prompted the decision to exempt from KanCare for one year the home- and community-based services for people with developmental disabilities.

Brownback, who is seeking re-election in 2014, intended to fold these 8,500 people into the KanCare mix Jan. 1, but federal officials withheld authorization. Negotiations led to an agreement between Kansas and federal officials Thursday allowing this final carve in of case management and services to occur Feb. 1.

On Thursday, Brownback said KanCare was improving health outcomes as coordination of medical and behavioral care was enhanced. Disabled people, he said, will experience better physical well-being and quality of life.

"We're raising the standard of expectations for outcomes and increasing access to care," said Lt. Gov. Jeff Colyer.

House Minority Leader Paul Davis, a Lawrence Democrat running for governor, said skepticism existed across Kansas that cost savings were directly related to changes in the behavior of disabled people. There is a sense the cash resulted from denial of services to intellectually or physically disabled Kansans, he said.

"I'd like to see waiting lists reduced and eliminated," Davis said. "My concern is the administration is shorting hospitals, other health care providers and a lot of Kansans who are Medicaid recipients in order to achieve these so-called savings."

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The Federal government says Brownback must open slots for 3,100 disabled people on the state's "unserved" waiting list. These disabled people QUALIFY for Medicaid, but have been DENIED long-term support services because the state DECLINED to earmark sufficient funding.

More than half of the states saw Obamacare as the complete disaster that it has turned out to be and refused to set up exchanges.
Brownback was only one of many governors that refused hook their wagon to a dead horse!

There is a very good chance Democrats will lose the senate in November due to
The Unaffordable Healthcare Act.
No reason to believe a liberal progressive like Davis won't be just as toxic running for governor!
Brownback November 2014

Provider reimbursements have NOT been cut under KanCare, as was done in other states and previous administrations in Kansas in order to reduce expenditures.
Providing better, more integrated and coordinated care that improves outcomes is the goal of KanCare and the source of savings. KanCare also includes built-in protections to ensure that consumers get the services they need.
Angela de Rocha
Kansas Department for Aging and Disability Services

Maybe reimbursements have not been cut under KanCare but payments are denied for the silliest of reasons. Stop splitting hairs and admit the reason for KanCare was to cut the cost of taking care of needy people in Kansas. How is that working? We have not been told how much money has been allocated to the state by the Federal Government for needy people and how much has been spent. What about that $40 million the governor wanted to take from KanCare and spend on full day kindergarten? Could that 40 million have been spent taking care of the developmentally disabled?

Delayed and denied payments from KanCare’s private insurance companies have gotten so bad that some service providers aren’t accepting Medicaid patients from certain companies.

Is this how privatization saves the state money? Is this what the providers of long-term care to Kansans with intellectual and developmental disabilities have to look forward to, now that the state has received federal approval to include these services in KanCare?

Deb Voth, president of Rainbows United in Wichita, told The Eagle editorial board that 90 percent of her agency’s billings to one of the managed-care organizations has not been paid. As a result, it is not accepting any more patients through that MCO.

Overall, nearly 50 percent of Rainbows’ billings to the three MCOs is in arrears, Voth said – and that is after Rainbows had an attorney shake some payments from the companies.

The Hutchinson Clinic sent a letter to its Medicaid patients last month telling them it might drop its contracts with two of the MCOs because of payments problems. Michael Harms, the clinic’s chief financial officer, told the Kansas Health Institute News Service that the clinic has had problems with “thousands of claims” and is behind “hundreds of thousands” of dollars in payments.

Though they haven’t dropped their contracts, other hospitals and clinics throughout the state also are frustrated with payment delays. Unpaid claims of 90 days or more at Wesley Medical Center and Via Christi Health in Wichita are double what they were prior to privatization.

Denied claims are also an issue. Between January and November 2013, more than 2.2 million KanCare claims were denied – about 16 percent of all claims. Wesley had more than $3.7 million in denied claims last year.

The delays and denials have been particularly hard on smaller providers, which have limited financial or legal resources.

Carrie Barker, who owns A 2 Z Helping Hands – a home health company with offices in Derby and Arkansas City – told The Eagle that she hasn’t received about $50,000 in reimbursements from the three MCOs.

“I feel like they’re trying to run us out of business, but they’ll still get their money (from the state),” she said.

Bureaucratic hassles also have increased the administrative costs of providers. Wesley had to hire additional staff to manage billing issues. Rainbows paid more than $15,000 in legal fees to negotiate autism contracts with the MCOs.

The state withheld 3 percent of its payments to the MCOs last year as an incentive to meet certain performance requirements, such as prompt processing of claims. State officials say they won’t know until early spring whether the companies will receive their 3 percent withholdings.

But even if it keeps all or part of those withholdings, that won’t help the hospitals and clinics still waiting to get paid.

KanCare - the state’s program to hand over public health coverage for the poor and disabled to for-profit insurers - has been mired with problems since its initial roll out.

Among those problems, local hospitals and clinics now are saying they are struggling to receive payments from at least two of the three coverage providers - Amerigroup, United Health Care and Sunflower State Health - for the services they’ve performed.

The Hutchinson Clinic sent a letter to KanCare members last month explaining its issues with Amerigroup and United Health Care. Hutchinson Regional Medical Center and Pratt Regional Medical Center also both report a growing number of KanCare accounts that are more than 90 days past due and that extra staff time is being devoted to handling KanCare payments.

Beginning Feb. 1, the state’s intellectually and developmentally disabled population will fall under KanCare, and it’s almost certain that Kansans will hear of additional problems surrounding coverage for this unique population.

Many of the problems surrounding KanCare seem to stem from efforts to steamroll the program through - fundamentally altering the state’s approach to health coverage for the poor and disabled without pausing sufficiently to consider the logistical problems that could emerge.

KanCare might well prove to be an effective and efficient way to provide health coverage to the state’s disadvantaged residents. But that’s not the case currently. Hospitals are on the hook for back payments, and patients are left navigating a sea of red tape.

The move to KanCare was pushed through in an effort to strike while the iron was hot, so to speak. The governor wanted it, the Legislature largely supported it, and there seemed to be little reason to delay implementation in order to learn more about the details.

As hospitals and clinics deal with nonpayment or delayed payments for services, other customers likely will be asked to pay more for their care or to pay more money in advance to offset the lagging, or sometimes nonexistent, payments from KanCare providers.

The Kansas Hospital Association told The News it is working with KanCare providers, the state, and local hospitals and clinics to address the payment issues. That’s nice, but it’s work that could’ve been done in advance of the program’s rollout.

Even now, parents and agencies that assist the developmentally disabled aren’t sure of what the change to KanCare will mean for their loved ones. Nevertheless, the state is forging ahead with a carve-in of that population, despite repeated and passionate expression of concern from the people who will deal with these decisions on a daily basis.

When an opportunity to impose an ideology trumps thoughtfulness and consideration for the state’s residents, it tends to look an awful lot like KanCare and its pothole-filled beginning.

A large majority of Kentucky adults support the state’s decision to expand Medicaid coverage to cover more-income people, a new poll shows. States have the option to extend Medcaid coverage under the Patient Protection and Affordable Care Act.

The Kentucky Health Issues Poll released Friday found that 51 percent of adults strongly favor the expansion while 28 percent somewhat favor the expansion. The poll also found that nearly 8 in 10 Kentucky adults or 77 percent reported hearing something about kynect, the insurance exchange the state set up under Obamacare. More than 160,000 Kentuckians have used the exchange to sign up for coverage.

The poll was paid for Norwood-based Interact for Health and the Louisville-based Foundation for a Healthy Kentucky. The poll was conducted Oct. 25 to Nov. 26, 2013 by the University of Cincinnati’s Institute for Policy Research via cell and landline telephones. The poll’s statewide results have a margin of error of plus or minus 2.5 percentage points.

Historically, Medicaid has provided coverage for low-income children, parents and pregnant women, as well as the blind, elderly and disabled. The Affordable Care Act provides funding for states to increase Medicaid eligibility to all residents with incomes up to 138 percent of the federal poverty level.

Kentucky was one of 25 other states, including Ohio, and the District of Columbia that have or plan to expand Medicaid. One reason that some states, such as Indiana, have been reluctant to expand the program is concerns that the federal government may someday cut back on its share of Medicaid funding.

The new poll found that large majorities of all demographic groups, including Democrats, Republicans and independents, favor Medicaid expansion. “We know that Kentuckians care about each other and access to affordable health care for everyone in the Commonwealth, and the results of this poll prove exactly that,” said Cara Stewart, health law fellow at the Kentucky Equal Justice Center, in a release.

Similarly, the poll showed nearly 9 in 10 adults or 87 percent reported that it was very or somewhat important that Kentucky Medicaid provides coverage to low-income people.

You seem to very intent on separating yourself from any kind of government programs and assistance, no matter your situation... In this spirit, I would encourage you to decline your government sponsored Medicare and Social Security benefits as a starter. Show those crazy teet suckers you are not going to join in that game!

Where were the critics like Rocky Nichols and the rest of you when the unserved and underserved waiting list started? Was it because they started in the first term of the Kathleen Sebelius administration and Rocky was her lap dog?

Somewhat ironic that the same Kathleen Sebelius who started these waiting as Governor in Kansas ... now demands that a different Governor fix the problem she created. Kind of sounds like ObamaCare .... the next Presidential administration will have to fix the problems created in this one.

Your RIGHT! The Gov. owes it to you.... But, it is a government program... With regard to Medicaid and other safety net programs and benefits, the government may not "owe" it you, but it was implemented as it the "RIGHT" thing to do.

I look it at like this...
If I drive up to Walmart in a down pour of freezing raining and their is only two parking spots left. One is the first spot, closest to the door, but is handicapped and the other is in the far corner at the end of the lane, I will GLADLY brave the elements from the edge of the lot.

The idea being, I thank GOD, I can... I will gladly give up a portion of my taxes to care for those that can not. That is very least I can do.